{
  "abstract": "BACKGROUND: Fibromuscular dysplasia (FMD) is a nonatherosclerotic arteriopathy that increases the risk of intracranial aneurysm and arterial dissection. Direct carotid-cavernous fistula (CCF) associated with FMD is rare, and the endovascular treatment strategy is not well established.\n\nOBSERVATIONS: A 52-year-old woman developed a high-flow CCF in the setting of bilateral internal carotid artery FMD. Three-dimensional rotational angiography under balloon test occlusion (BTO) enabled precise localization of the fistula proximal to a cavernous-segment aneurysm. Transvenous selective embolization was achieved through the pterygoid plexus, while the transarterial approach through the FMD-affected ICA was performed safely with a flexible distal access catheter.\n\nLESSONS: In FMD-associated CCF, accurate localization of the shunt using BTO and meticulous endovascular technique allowed for safe embolization. The pterygoid plexus proved to be a useful and feasible access route.\n\nhttps://thejns.org/doi/10.3171/CASE26625",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan",
    "Neurovascular Research Unit, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts",
    "Critical Care Medical Center, Nippon Medical School Hospital, Nippon Medical School, Bunkyo-ku, Tokyo",
    "Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ryunosuke Haruta",
      "orcid": "0009-0002-5955-270X"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Satoshi Murai",
      "orcid": "0000-0001-8395-072X"
    },
    {
      "affs": [
        0
      ],
      "name": "Masato Maruno"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Shodai Yamada"
    },
    {
      "affs": [
        0
      ],
      "name": "Yoshifumi Tao"
    },
    {
      "affs": [
        0
      ],
      "name": "Yukari Minami-Ogawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Satoshi Hirai"
    },
    {
      "affs": [
        0
      ],
      "name": "Satoshi Inoue"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Kenji Yagi",
      "orcid": "0000-0001-9392-5827"
    },
    {
      "affs": [
        0
      ],
      "name": "Tomohito Hishikawa"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d8acpw2v19n69.bib",
  "cited_by": 0,
  "doi": "10.3171/case26625",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13700073/",
  "id": "d8acpw2v19n69",
  "issns": [
    "2694-1902"
  ],
  "landing_url": "https://doi.org/10.3171/case26625",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Case Lesson"
    ],
    [
      "openalex",
      "2728|Vascular Malformations Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7224026649",
  "pdf_url": "https://europepmc.org/articles/PMC13700073?pdf=render",
  "pmcid": "PMC13700073",
  "pmid": "42933010",
  "published": "2026-10-26",
  "publisher": "American Association of Neurological Surgeons",
  "ris": "https://research.draconitic.com/paper/d8acpw2v19n69.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:35Z",
      "native_id": "PMC13700073",
      "source": "pmc",
      "url": "https://doi.org/10.3171/case26625"
    },
    {
      "first_seen": "2026-10-30T12:21:51Z",
      "native_id": "MED:42933010",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42933010"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Vascular Malformations Diagnosis and Treatment",
      "subfield": "neurology"
    }
  ],
  "title": "Transvenous embolization via the pterygoid plexus for a direct carotid-cavernous fistula associated with fibromuscular dysplasia: illustrative case",
  "title_text": "Transvenous embolization via the pterygoid plexus for a direct carotid-cavernous fistula associated with fibromuscular dysplasia: illustrative case",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:36:33Z",
  "url": "https://research.draconitic.com/paper/d8acpw2v19n69",
  "venue": "Journal of Neurosurgery: Case Lessons",
  "versions": []
}